How to Handle Intrusive Thoughts: A Therapist’s Guide to What They Are and What Actually Helps

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10.21.2026

### There’s a story I like to tell in sessions.

Many days, as I drive home, I cross a bridge with a beautiful view of the water. As I go across it, I typically look at the water and think about how lovely it is.

After that, my next thought is almost always “what would happen if I accidentally turned the wheel toward the water and went over the edge?”

THAT is an example of an intrusive thought.

#### What Is an Intrusive Thought?

It is an unwanted, scary, thought or image that pops into your head without conscious effort or desire that is hard to dismiss. There may be a trigger – I am driving over the bridge – but it is otherwise a thought that doesn’t make much sense. To be clear, I’m not sad, or depressed, and have no interest in driving off a bridge.

Luckily, I AM an anxiety and OCD therapist, so I know what an intrusive thought is, and it doesn’t scare me. In fact, most people have an occasional intrusive thought, and it doesn’t affect them much.

#### Why Intrusive Thoughts Feel Terrifying When You Have OCD

However, for people with OCD, intrusive thoughts can be quite terrifying. A thought like mine may be followed with thoughts like: “Why am I thinking that? What’s wrong with me? Am I crazy? Do I want to die and don’t know it? Am I going to lose control and turn the wheel?!!”

#### The Many Forms Intrusive Thoughts Take

Folks can have all kinds of intrusive thoughts, from picturing themselves falling off the subway platform, to imagining stabbing someone, to thinking about something bad happening to a loved one.

If the thought is easy to dismiss and not scary – no problem. But if it is “sticky” and scary and overwhelming, that is a good indication that you should speak with an OCD specialist to learn ways to manage the fears.

#### How to Deal with Intrusive Thoughts: Start by Understanding Them

One of the first steps in treating OCD is understanding it. Talking about the intrusive thoughts and fears, and learning to recognize that they are OCD, is a really helpful piece of learning not to be afraid.A thought, after all, is just a thought – it doesn’t create reality, or make actions happen.

We get to choose our actions, even if we can’t choose our thoughts and feelings.

#### ERP: The Most Important Part of OCD Treatment

The next step is understanding that fear begets fear. If you avoid situations out of fear, the fear will get stronger. In fact, the most important part of OCD treatment is something called ERP: Exposure and Response Prevention.

Exposure means facing the intrusive fear. Response prevention means not doing whatever the thing is that OCD tells you to do to avoid the fear. For example, if you have an intrusive fear of stabbing someone, we would work on holding sharp knives with other people in the room.

#### What OCD Therapy Looks Like Step by Step

In therapy, we start with understanding and mapping the OCD and anxiety. We may integrate some coping tools, like diaphragmatic breathing or distraction. Then, we track ways you are responding to those fears – compulsions or avoidances. After that, we gradually work our way up from easiest to hardest with ERP.

#### You Don’t Have to Be Alone With the Fear

Though it isn’t always easy, getting proper help for intrusive thoughts can be life-changing. You don’t have to be alone with fear. Reach out today – we’re here to help.

Tamar Gordon, PhD

Tamar Gordon, PhD

Dr. Tamar Gordon is the Founder and Clinical Director of the Gordon Therapy Group in New York. A graduate of Harvard University, St. John’s University, and the NYU Child Study Center’s Post-Doctoral Program, she is passionate about helping people with …

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